Yerenis Garcia

· Monitor accounts routed to assigned work queues; responsible for clearing work queues in accordance with established management guidelines.

· Maintain knowledge of and comply with commercial and government payer requirements for obtaining pre-certifications/prior authorizations, and completes other activities to facilitate financial clearance prior to services being rendered.

· Utilize appropriate strategies including on-line databases, electronic correspondence, and phone calls to obtain required pre-certifications and prior authorizations.

· Coordinate with insurance companies to obtain pre-certifications/prior authorizations for patients’ scheduled services as needed, documenting information such as precertification/prior authorization numbers within the Epic environment.

· Collaborate with patients, providers, and departments to ensure all necessary information is obtained prior to patients’ scheduled services, or retroactively when necessary.

· Communicate with patients, providers, and other departments such as Utilization Review regarding issues or problems in obtaining required pre-certifications/prior authorizations.

· Maintain knowledge of CMS requirements and guidelines, as provided by department leadership and/or training.

· Maintain confidentiality of patient’s financial and medical records: adheres to the State and Federal laws regulating collection in healthcare, ensure that the Federal Threat and Identity Rule is enforced, adhere to enterprise and other regulatory

• Trained staff on current eligibility requirements and policies.
• Completed administrative patient intakes with case histories, insurance information and mandated forms.
• Conducted patient intake interviews, recording and documenting relevant information.
• Prepared and processed patient referrals and transfer requests.
• Performed various administrative tasks by filing, copying and faxing documents.
• Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
• Engaged wider departments in accurate, timely paperwork completion.
• Contact insurance companies for both outpatient and inpatient surgeries
• Request authorizations for multiple different specialties across multiple platforms
• Communicated verification and authorization status updates with departments to facilitate decision-making for patient admissions and insurance coverage.
• Assured timely verification of insurance benefits prior to patient procedures or appointments.
• Trained new staff on current, correct insurance verification procedures.
• Established and maintained relationships with insurance providers for productive communications.
• Updated patient records with accurate, current insurance policy information.
• Achieved insurance pre-authorizations to enable timely patient procedures.
• Assisted patients with understanding personalized insurance coverage and benefits.
• Assisted with medical coding and billing tasks.
• Complied with HIPAA guidelines and regulations for confidential patient data.
• Made contact with insurance carriers to discuss policies and individual patient benefits.
• Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
• Maintained strong knowledge of basic medical terminology to better understand services and procedures.
• Delegated pending accounts to fellow team members
• Provided coverage for department supervisor
• Met productivity metrics of 80 patients cleared per day

• Evaluated employee performance and conveyed constructive feedback to improve skills.
• Established team priorities, maintained schedules and monitored performance.
• Maintained professional demeanor by staying calm when addressing unhappy or angry customers.
• Coached new hires on company processes while managing employees to achieve maximum production.
• Identified and communicated customer needs to supply chain capacity and quality teams.
• Used industry expertise, customer service skills and analytical nature to resolve customer concerns and promote loyalty.
• Updated reports, managed accounts, and generated reports for company database.
• Cultivated positive rapport with fellow employees to boost company morale and promote employee retention.
• Established workflow processes, monitored daily productivity, and implemented modifications to improve overall performance of personnel.
• Developed detailed plans based on broad guidance and direction.
• Developed and maintained successful relationships with vendors, suppliers and contractors.
• Improved safety procedures to promote employee well-being and safety and protect company from potential liability.
• Created, maintained and updated filing systems for paper and electronic documents.
• Maintained computer and physical filing systems.
• Oversaw office inventory activities by ordering and requisitions and stocking and shipment receiving.
• Recruited, interviewed and hired employees and implemented mentoring program to promote positive feedback and engagement.
• Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.

• Trained new staff on hospital processes and procedures.
• Helped address client complaints through timely corrective actions and appropriate referrals.
• Identified insurance payment sources and listed payers in proper sequence to establish chain of payment.
• Answered incoming calls, scheduled appointments and filed medical records.
• Engaged with patients to provide critical information.
• Received patient deductibles and co-pay amounts and discussed options to satisfy remainder of patient financial obligations.
• Providing excellent customer service by promptly answering patient inquiries.
• Delivered support to medical staff in completion of patient paperwork.
• Greeted and assisted patients with check-in procedures.
• Processed payments using cash and credit cards, maintaining accurate records of transactions.
• Applied administrative knowledge and courtesy to explain procedures and services to patients.
• Collected and entered patient demographic and insurance data into computer database to establish patient's medical record.
• Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
• Verified patient insurance eligibility and entered patient information into system.
• Addressed bad debts in line with set protocols.
• Obtained patient's insurance information and determined eligibility for benefits for specific services rendered.
• Trained new staff on filing, phone etiquette and other office duties.
• Facilitated communication between patients and various departments and staff.
• Offered simple, clear explanations to help clients and families understand hospital policies and procedures.
• Utilized knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks.
• Responded to inquiries by directing calls to appropriate personnel.
• Stayed calm under pressure to and successfully dealt with difficult situations.
• Provided excellent customer service to patients and medical staff.

• Audited and corrected billing and posting documents for accuracy.
• Entered invoices requiring payment and disbursed amounts via check, electronic transfer or bank draft.
• Produced and mailed monthly statements to customers and assisted with related requests for information and clarification.
• Responded to customer concerns and questions on daily basis.
• Utilized various software programs to process customer payments.
• Provided excellent customer service, developing and maintaining client relationships.
• Assisted with billing inquiries and provided timely responses to enhance customer satisfaction.
• Used data entry skills to accurately document and input statements.